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This paper concentrates on the application of theories to social work practice involving mental health issues and on the recommendations given to the social worker in order to illustrate how the highly theoretical matters can be used in the real life. This essay will deal with the importance of applying theories in clinical settings and the effects this can have on quality of care. Barriers to using theory in practice will be explored, as will the roles that practitioners, managers, theorists and educators can play in encouraging the development and use of theory-based practice. The use of CNO and RNAO related strategies will also be discussed.
In this paper, I am providing illustrations of the application of the fist principle of Parse Theory of Human Becoming, that of imaging, valuing, and languaging. While working with Mr. J I gradually realized that on reflecting on his being and his newfound inner wisdom, power, and strength, he was getting hopeful about his future.
Realization of the process of illuminating meaning can be strengthened by an understanding of the ideas of imaging, valuing, and languaging, the three notions Parse (1981) believed were inherent in the course of informative meaning. I got to know some of Mr. J’s unfolding patterns of realizing as we spent time together. He had originally formed his knowledge of his condition and well-being from what researchers were able to confirm to him or from what he could provide evidence to himself (or both). When he realized that he had attempted to commit suicide, he allowed himself the freedom to admit and honor his inner understanding of what was “right” in his life. Mr. J’s pattern of realizing transformed to include infinite possibilities for health but not disease. In getting to know the boundaries beyond the physical body, Mr. J embraced the strength of the mind and spirit and the erroneous assumptions of his whole being. Imaging is the distinctive uncovering of the senses that are of importance in our experiences, senses that are formed from our altering ways of knowing (Parse 1981).
It can be stated that valuing is the structuring of an individual ontology. In other words, it is the perceptive of the values and beliefs that support our perceptions of realism (Parse, 1981). It is an on-going process that alters over time. In getting to know our patterns as well as our worth and convictions, we can simultaneously identify our healing path (whether knowingly, subconsciously, or both) and move toward that which shapes our lives in the new way. Mr. J initially related that his values and beliefs circled around his confidence that everything in his life (neighbors, children, etc) came first and that being anxious about them meant caring for them. As time went by, he came to the understanding that by caring about himself and by doing things or being in ways that added to his happiness, he, as a result, could be happy in the time he spent with people around him. He stated that his anxiety also turned into acceptance of the fact that wanted to commit suicide. Mr/ J’s values and convictions, although altering over time, affected the meaning he provided to his present experiences as he recognized and awoke to the call to like the life in its every form.
“Languaging” is the sense of a person’s experiences as described by that individual (Parse1981). It is the example of perceptions, thoughts, and signs related to our experiences and healing journey. While dealing with Mr. J I realized that languaging can aid patients and families put their abstract and often confusing thoughts together in a structured and personally meaningful manner. It can aid them make sense of what is taking place in their lives. I found that with each successive day talking to Mr. J, he often added deepness to his previous day’s thoughts, insights, and discussions having to do with health and healing.
I also noticed that to smooth the progress of languaging, my own languaging has become very crucial. At times when I unintentionally reverted back to my effort to control situation and fix Mr. J problems, I in effect would establish barriers between myself and Mr. J and, as a result, block further verbal expression from him. For example, when I was truly present with Mr. J by giving him my full attention and by not communicating from my individual agenda based on suppositions, he became far more open with his answers and forthcoming with subjective feedback on his suicide problems and healing needs. In becoming alert to the processes involved in the discovering perceived meanings, we as social workers also can start to illuminate our own healing paths through the identification of meanings within life practices.
To continue, my experience with applying theory into practice goes in line with the CNO ethical standards and RNAO (respect to the client) approaches, which can also be traced to Parse (1995) concept of imaging. As depicted in my example of caring for this young male in his 20’s, the abstract idea imaging reveals the facts about the ways Mr. J creates his own personal knowing in the sense of his selected meanings and ordered realities. While working with Mr. J I attempted to persuade him that imaging is about being aware and coming to realize. At first, this patient I worked with complained that he couldn’t really understand the meaning of imaging notion as it was highly hypothetical concept and non-specific, but when we started going through concrete examples and did a few exercises on imaging, Mr. J mentioned that it became clear how realization and knowledge developed beyond what was provided in the abstract notions.
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A practice situation with this young man, who suffered had problems with self-esteem, drinking and attempted to kill himself on the constant basis, demonstrates how his scrupulous experience of imagining what might be aids doctors and social workers to better fathom the hypothetical notion of imaging. My realization of how Mr. J lives the abstract concept imaging was bettered through this knowledge. Also, based on the CNO perspective, the imaging theory used by me significantly helped Mr. J. This young person showed some progress, and he did come to know his reality in various ways. It is exciting that he also imagined himself full of energy ad strength again and indicated that he often dreamt about walking and running and this patient really wanted to keep having these dreams as they aided him to feel like he used to do in the past. In this particular example, we can see how persons co-transcend with the possibilities at multiple representation of the universe (Parse 1995).
The researcher reminds us that scientific disciplines like social science and nursing encompass more than one paradigm with which to guide practice and research. Each paradigm, or world view, gives rise to several theories. The theories reflect the belief and value system of the parent paradigm so that the concepts and propositions within a theory are congruent with the views set forth in the paradigm (like me caring for Mr. J). Therefore, the development of science occurs within the context of paradigms (Parse 1995). According to Parse (and supported by my practical experience of caring for the young patient with self-esteem problems and repeated attempts to suicide), social work science has developed and continues to develop within two almost contradictory paradigms.
These are the totality and simultaneity paradigms. Parse has argued that these two paradigms are unique to the fields of social work and nursing. He also argues that all aspects of such knowledge can be categorized into one or other of these paradigms. The totality paradigm sees the person as an organism whose nature is a composite of bio-psycho-social and spiritual dimensions. The environment is the internal and external stimuli surrounding the person. The person has to manipulate and interact with the environment in order to achieve goals and to maintain health, which is viewed as a dynamic state of bio-psycho-social-spiritual integrity and balance. Social work focuses on health promotion, care and cure of the sick and the prevention of illness, while those receiving social work care are people who are viewed as ill by society (Parse 1993).
The totality paradigm, just like the theories adopted by CNO, has been, and on the authority of Parse continues to be, the predominant paradigm in social work and nursing. The resultant theories tend to centre on helping the sick individual to adapt, undertake self-care, interact and attain health. Within these conceptualizations, the authority figure and prime decision maker is the social worker. Such practice is guided by a linear process approach whereby the patient’s problems are assessed, a plan of care is drawn up, interventions are undertaken and the results are evaluated. The totality paradigm gives rise to research which is quantitative in nature and where causal and associative relationships are testable.
In contrast, the simultaneity paradigm is a more radical view of the world of social work. It was first propounded by Martha Rogers (1970) and elaborated upon by Parse (1981). The simultaneity paradigm differs from the totality paradigm in three significant ways:
• In its assumptions about the person and health;
• In relation to the goal of social care;
• In the implications for research and practice.
Within the simultaneity paradigm the person is viewed as a unitary being who is in continuous mutual and simultaneous interaction with the environment. People are viewed as different from, and more than, the sum of their parts. They give meaning to situations and, as ‘open beings’, are responsible for choices in moving beyond what exists at present (Parse, 1981). Health is viewed as a ‘process of becoming’ and as a set of value priorities. Health is experienced by the individual and therefore can only be described by that individual. There is no optimum health: health is how one experiences personal living.
We have to note that theories invented in an academic setting need considerable adjustment when applied to the vagaries of particular clinical situations. If this is not done and the theory is applied in a rigid fashion, the result may be confusion and apathy. However, we should be wary of making widespread alterations to a theory in case its original theoretical meaning is lost. As with selecting theories, taking an eclectic approach to theory application fails to recognize that concepts arise within the context of particular theories, and their meaning may be compromised if taken out of context and placed within a different theory.
Research approaches within this paradigm are mainly qualitative in nature. In 1987, Parse believed that such a methodological approach was a start and stressed that new methods more suitable to the simultaneity paradigm would be forthcoming. In her 1995 book, Illuminations, Parse describes a research approach which is more in keeping with the simultaneity philosophy.
To continue, Thomas Kuhn (1970) proposed that a discipline goes through a period of normal science where one paradigm becomes more central. This period ends in crisis when the accepted paradigm fails to account for new phenomena that may have arisen as a result of social change or scientific discovery. A revolution then occurs and a new paradigm becomes the accepted way of viewing research, theory and practice. Currently, the simultaneity paradigm is gaining in recognition and increasingly is being used to guide research, education and practice. Perhaps we are witnessing a Kuhnian shift from the totality paradigm to the simultaneity paradigm, and those social work theories belonging to the former will soon be relegated to the archive of past knowledge base (Clark, 1986).
In the three decades from the 1950s to the 1970s there seemed to be a reluctance to criticize the work of social work theorists. Perhaps the main reason for this was that most social workers had not the theoretical and philosophical knowledge base necessary to mount a coherent critique. Nevertheless, in the 1980s and 1990s grand theories in social work underwent a degree of criticism and their many disadvantages were highlighted. Webb (1986a) differentiates between low-level and high-level criticisms, the former being more easily overcome than the later. The low-level criticisms can be summarized as follows:
1 Too many theories: At last count there were approximately fifty grand social work theories and several dozen mid-range theories. It would be almost impossible for hard-pressed clinicians to be aware of all these theories, nor, according to Clark (1986), should they be so.
2 Jargon: most of the available theories are characterized by difficult language. This has been referred to as abstract jargon and semantic confusion (Hardy, 1986). This is seen as contributing to the unmanageability of theories in practice. There is also the danger that the use of this jargons will lead to widespread confusion, not only among social workers but also among the public. Although acknowledging the overuse of jargon in theories, Aggleton and Chalmers (1987) believe its identification as a major criticism is unduly cynical.